An infection is an invasion of the body by a pathogen (any micro-organism that causes disease) and the resulting signs and symptoms that develop in response to the invasion. Infections can be divided into two categories: localized and systemic. A localized infection is limited to a small area. Systemic infections are wide spread throughout the body and are often spread via the blood.1
Sepsis– is a diffuse inflammatory systemic response to a chemical, mechanical, bacterial or microbial assault; if untreated, it can lead to shock.2
Etiology and Pathophysiology 1) A bodily insult leads to an inflammatory response, which is intended to protect the body from further injury and promote healing. 2) Vascular response consists of a massive release of histamine, prostaglandin, bradykinin, and other mediators, which cause vasodilation and increased capillary membrane permeability and inititiation of the clotting cascade. 3) This maldistribution of circulating blood volume causes decreased cellular O2 supply, impaired tissue perfusion and impaired cellular metabolism; impaired perfusion can be monitored by increasing saturation of central venous oxygenation (ScvO2) and level less than 70% indicates significant problem with systemic O2 delivery. 4) Severe sepsis, which is characterized by hypoperfusion, organ dysfunction, and hypotension, can lead to septic shock and death caused by multiple organ system failure. 5) In early sepsis (the hyperdynamic phase), the body attempts to compensate for the decreasing oxygenation at the cellular level; the heart rate and respiratory rate increase and urine output decreases because of shunting of blood to vital organs, the body temperature increases as the metabolic activity increases, and the skin becomes warm and flushed because of vasodilation. 6) In the late stage of sepsis, compensatory mechanisms begin to fail; SNS compensatory mechanisms cause extreme tachycardia but CO is low because of vasoconstriction and poor stroke volume; peripheral pulses become weak or absent and skin becomes cool, pale, and cyanotic (vasoconstriction); respirations becomes labored and decreased because of toxin accumulation and hypoxia in the CNS; the LOC decreases to coma because of severe hypoxia.2
Signs and Symptoms2
Early Signs:
Fever >38°C (100.4°F) or <36°C (96.8°F)
Tachypnea
Hypocarbia
ScvO2 <70%
Tachycardia
Restlessness
Hyperglycemia
Late Signs:
Diminished LOC
Coma
Respiratory failure
Heart Failure
Oliguria
Medications for Infection:
Prophylactic Medications:
Antibiotics when person's ANC is very low
Antibiotic therapy is started right away at the first sign of infection.
When the specific germ is identified, the antibiotic may be continued or changed depending on the the type.
Colony Stimulating Factors (CSF)
Used when the infection is not responding to antibiotic therapy
Boost WBCs so patient can fight infection.
Bacterial Infection:
Broad Spectrum Antibiotics
Viral Infections:
Anti-viral drugs
Acyclovir
Valganciclovir
Fungal Infections:
Anti-fungal
nystatin (oral)
Nursing Interventions for Infection:
Monitor temperature frequently
Monitor BP, apical pulse, and respirations frequently.
Draw and send CBC, blood
Obtain specimens
blood
urine
wound drainage or pus
sputum
Management of Fever:
administer antipyretic medications
monitor VS
monitor I & O
Encourage increase of fluids
Administer IV fluids, as appropriate
cover patient with a sheet only.
Teach patients about preventing Infections.
Preventing Infections:
Avoid crowds or large gathers, or people that may be ill
Do not share utensils or personal hygiene items
WASH YOUR HANDS frequently/good personal hygiene habbits
Get immunizations (not live virus if immune system is compromised)
Consume a low bacteria diet, avoid under-cooked meat and raw fruits and vegetables
Be aware of signs and symptoms of infection.
Medications for Sepsis:
Combat sepsis
Antibiotic therapy must begin before organism is identified, so multiple drugs are prescribed
Common ones include vancomycin, aminoglycosides, systemic penicillin or cephalosporins, macrolides, and quinolones
When bacteria is identified, IV antibiotics are given specific to cause
Adrenal insufficiency
Low-dose corticosteroids for at least 7 days
Usually IV hydrocortisone and oral fludrocortisone
Hyperglycemia
Insulin therapy to maintain blood glucose lower than 150 mg/dL
Clotting problems
Heparin therapy
Activated protein C to manage microvascular abnormalities/prevent bleeding
Blood replacement therapy
If septic shock progresses to hemorrhage
Nursing Interventions for Sepsis:
Maintain airway, oxygen therapy
Draw and send CBC, blood cultures, tests to lab per physicians order
Find cause of decreased perfusion
Protect organs from dysfunction
Fluid replacement
Drug therapy as prescribed
Medications for sepsis, adrenal insufficiency, hyperglycemia, and clotting problems
Lewis, S.L., Heitkemper, M. M., Dirksen, S.R., O’Brien, P.G., Bucher, L. Medical-Surgical Nursing. 7th Ed. p243. Mosby Elsevier.(2007).
Ignatavicius, Donna D., and M. Linda. Workman. Medical-surgical Nursing: Patient-centered Collaborative Care. St. Louis, MO: Saunders/Elsevier, 2010. 838-44. Print.
Ignatavicius, Donna D., and M. Linda. Workman. Medical-surgical Nursing: Patient-centered Collaborative Care. St. Louis, MO: Saunders/Elsevier, 2010. 451-452. Print.
Infection and Sepsis
An infection is an invasion of the body by a pathogen (any micro-organism that causes disease) and the resulting signs and symptoms that develop in response to the invasion. Infections can be divided into two categories: localized and systemic. A localized infection is limited to a small area. Systemic infections are wide spread throughout the body and are often spread via the blood.1
Sepsis– is a diffuse inflammatory systemic response to a chemical, mechanical, bacterial or microbial assault; if untreated, it can lead to shock.2
Etiology and Pathophysiology
1) A bodily insult leads to an inflammatory response, which is intended to protect the body from further injury and promote healing.
2) Vascular response consists of a massive release of histamine, prostaglandin, bradykinin, and other mediators, which cause vasodilation and increased capillary membrane permeability and inititiation of the clotting cascade.
3) This maldistribution of circulating blood volume causes decreased cellular O2 supply, impaired tissue perfusion and impaired cellular metabolism; impaired perfusion can be monitored by increasing saturation of central venous oxygenation (ScvO2) and level less than 70% indicates significant problem with systemic O2 delivery.
4) Severe sepsis, which is characterized by hypoperfusion, organ dysfunction, and hypotension, can lead to septic shock and death caused by multiple organ system failure.
5) In early sepsis (the hyperdynamic phase), the body attempts to compensate for the decreasing oxygenation at the cellular level; the heart rate and respiratory rate increase and urine output decreases because of shunting of blood to vital organs, the body temperature increases as the metabolic activity increases, and the skin becomes warm and flushed because of vasodilation.
6) In the late stage of sepsis, compensatory mechanisms begin to fail; SNS compensatory mechanisms cause extreme tachycardia but CO is low because of vasoconstriction and poor stroke volume; peripheral pulses become weak or absent and skin becomes cool, pale, and cyanotic (vasoconstriction); respirations becomes labored and decreased because of toxin accumulation and hypoxia in the CNS; the LOC decreases to coma because of severe hypoxia.2
Signs and Symptoms2
Early Signs:
Late Signs:
Medications for Infection:
Nursing Interventions for Infection:
Preventing Infections:
Medications for Sepsis:
Nursing Interventions for Sepsis:
Nursing Journal – “Managing Sepsis” by Sarah Holling
http://prox1.harpercollege.edu:2052/ehost/pdfviewer/pdfviewer?sid=25418455-a53f-4abe-8d1d-d3f989c2d64b%40sessionmgr11&vid=4&hid=13
References:
American Cancer Society. Infections in People With Cancer. Retrieved 21 January 2012 from
http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/InfectionsinPeoplewithCancer/infections-in-people-with-cancer
Hogan, M.A., Davenport, J., Estridge, S., Zygmont, D. Medical-Surgical Nursing. 2nd Ed. pp.672-673. Pearson Prentice Hall. (2008)
Lewis, S.L., Heitkemper, M. M., Dirksen, S.R., O’Brien, P.G., Bucher, L. Medical-Surgical Nursing. 7th Ed. p243. Mosby Elsevier.(2007).
Ignatavicius, Donna D., and M. Linda. Workman. Medical-surgical Nursing: Patient-centered Collaborative Care. St. Louis, MO: Saunders/Elsevier, 2010. 838-44. Print.
Ignatavicius, Donna D., and M. Linda. Workman. Medical-surgical Nursing: Patient-centered Collaborative Care. St. Louis, MO: Saunders/Elsevier, 2010. 451-452. Print.
http://www.beaconcollaborative.org/assets/files/Sepsis_Tool_Kit/CPMC-Sepsis-PnP.pdf
http://prox1.harpercollege.edu:2052/ehost/pdfviewer/pdfviewer?sid=25418455-a53f-4abe-8d1d-d3f989c2d64b%40sessionmgr11&vid=4&hid=13
Link: http://www.youtube.com/watch?v=GkiPq6VEGsU&feature=related
Link: http://www.youtube.com/watch?v=HoxoeP-l5Uw
http://www.cdc.gov/cancer/preventinfections/pdf/neutropenia.pdf
Link: http://www.syracusemedicalmalpracticelawyerblog.com/New%20York%20sepsis%20wrongful%20death%20lawyers.png
BY: Mark Contreras, Cassy Johnston, and Vicky Koss